Social and behavioral risk reduction strategies for tuberculosis prevention in Canadian Inuit communities: a cost-effectiveness analysis
Abstract Background Tuberculosis (TB) is an important public health problem in Inuit communities across Canada, with an annual incidence rate in 2017 that was nearly 300 times higher than in Canadian-born non-Indigenous individuals. Social and behavioral factors that are prevalent in the North, such...
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crspringernat:10.1186/s12889-021-10187-z 2023-05-15T16:55:09+02:00 Social and behavioral risk reduction strategies for tuberculosis prevention in Canadian Inuit communities: a cost-effectiveness analysis Uppal, Aashna Oxlade, Olivia Nsengiyumva, Ntwali Placide N’Diaye, Dieynaba S. Alvarez, Gonzalo G. Schwartzman, Kevin Canadian Institutes of Health Research 2021 http://dx.doi.org/10.1186/s12889-021-10187-z http://link.springer.com/content/pdf/10.1186/s12889-021-10187-z.pdf http://link.springer.com/article/10.1186/s12889-021-10187-z/fulltext.html en eng Springer Science and Business Media LLC http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/licenses/by/4.0/ CC-BY BMC Public Health volume 21, issue 1 ISSN 1471-2458 Public Health, Environmental and Occupational Health journal-article 2021 crspringernat https://doi.org/10.1186/s12889-021-10187-z 2022-01-04T11:49:41Z Abstract Background Tuberculosis (TB) is an important public health problem in Inuit communities across Canada, with an annual incidence rate in 2017 that was nearly 300 times higher than in Canadian-born non-Indigenous individuals. Social and behavioral factors that are prevalent in the North, such as commercial tobacco use, excessive alcohol use, food insecurity and overcrowded housing put individuals at higher risk for TB morbidity and mortality. We examined the potential impact of mitigation strategies for these risk factors, in reducing TB burden in this setting. Methods We created a transmission model to simulate the epidemiology of TB in Nunavut, Canada. We then used a decision analysis model to assess the potential impact of several evidence-based strategies targeting tobacco use, excessive alcohol use, food insecurity and overcrowded housing. We predicted TB incidence, TB-related deaths, quality adjusted life years (QALYs), and associated costs and cost-effectiveness over 20 years. All costs were expressed in 2018 Canadian dollars. Results Compared to a status quo scenario with no new interventions for these risk factors, the reduction strategy for tobacco use was most effective and cost-effective, reducing TB incidence by 5.5% (95% uncertainty range: 2.7–11%) over 20 years, with an estimated cost of $95,835 per TB case prevented and $49,671 per QALY gained. The addition of the food insecurity reduction strategy reduced incidence by a further 2% (0.5–3%) compared to the tobacco cessation strategy alone, but at significant cost. Conclusions Strategies that aim to reduce commercial tobacco use and improve food security will likely lead to modest reductions in TB morbidity and mortality. Although important for the communities, strategies that address excess alcohol use and overcrowding will likely have a more limited impact on TB-related outcomes at current scale, and are associated with much higher cost. Their benefits will be more substantial with scale up, which will also likely have important downstream impacts such as improved mental health, educational attainment and food security. Article in Journal/Newspaper inuit Nunavut Springer Nature (via Crossref) Canada Nunavut BMC Public Health 21 1 |
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Public Health, Environmental and Occupational Health |
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Public Health, Environmental and Occupational Health Uppal, Aashna Oxlade, Olivia Nsengiyumva, Ntwali Placide N’Diaye, Dieynaba S. Alvarez, Gonzalo G. Schwartzman, Kevin Social and behavioral risk reduction strategies for tuberculosis prevention in Canadian Inuit communities: a cost-effectiveness analysis |
topic_facet |
Public Health, Environmental and Occupational Health |
description |
Abstract Background Tuberculosis (TB) is an important public health problem in Inuit communities across Canada, with an annual incidence rate in 2017 that was nearly 300 times higher than in Canadian-born non-Indigenous individuals. Social and behavioral factors that are prevalent in the North, such as commercial tobacco use, excessive alcohol use, food insecurity and overcrowded housing put individuals at higher risk for TB morbidity and mortality. We examined the potential impact of mitigation strategies for these risk factors, in reducing TB burden in this setting. Methods We created a transmission model to simulate the epidemiology of TB in Nunavut, Canada. We then used a decision analysis model to assess the potential impact of several evidence-based strategies targeting tobacco use, excessive alcohol use, food insecurity and overcrowded housing. We predicted TB incidence, TB-related deaths, quality adjusted life years (QALYs), and associated costs and cost-effectiveness over 20 years. All costs were expressed in 2018 Canadian dollars. Results Compared to a status quo scenario with no new interventions for these risk factors, the reduction strategy for tobacco use was most effective and cost-effective, reducing TB incidence by 5.5% (95% uncertainty range: 2.7–11%) over 20 years, with an estimated cost of $95,835 per TB case prevented and $49,671 per QALY gained. The addition of the food insecurity reduction strategy reduced incidence by a further 2% (0.5–3%) compared to the tobacco cessation strategy alone, but at significant cost. Conclusions Strategies that aim to reduce commercial tobacco use and improve food security will likely lead to modest reductions in TB morbidity and mortality. Although important for the communities, strategies that address excess alcohol use and overcrowding will likely have a more limited impact on TB-related outcomes at current scale, and are associated with much higher cost. Their benefits will be more substantial with scale up, which will also likely have important downstream impacts such as improved mental health, educational attainment and food security. |
author2 |
Canadian Institutes of Health Research |
format |
Article in Journal/Newspaper |
author |
Uppal, Aashna Oxlade, Olivia Nsengiyumva, Ntwali Placide N’Diaye, Dieynaba S. Alvarez, Gonzalo G. Schwartzman, Kevin |
author_facet |
Uppal, Aashna Oxlade, Olivia Nsengiyumva, Ntwali Placide N’Diaye, Dieynaba S. Alvarez, Gonzalo G. Schwartzman, Kevin |
author_sort |
Uppal, Aashna |
title |
Social and behavioral risk reduction strategies for tuberculosis prevention in Canadian Inuit communities: a cost-effectiveness analysis |
title_short |
Social and behavioral risk reduction strategies for tuberculosis prevention in Canadian Inuit communities: a cost-effectiveness analysis |
title_full |
Social and behavioral risk reduction strategies for tuberculosis prevention in Canadian Inuit communities: a cost-effectiveness analysis |
title_fullStr |
Social and behavioral risk reduction strategies for tuberculosis prevention in Canadian Inuit communities: a cost-effectiveness analysis |
title_full_unstemmed |
Social and behavioral risk reduction strategies for tuberculosis prevention in Canadian Inuit communities: a cost-effectiveness analysis |
title_sort |
social and behavioral risk reduction strategies for tuberculosis prevention in canadian inuit communities: a cost-effectiveness analysis |
publisher |
Springer Science and Business Media LLC |
publishDate |
2021 |
url |
http://dx.doi.org/10.1186/s12889-021-10187-z http://link.springer.com/content/pdf/10.1186/s12889-021-10187-z.pdf http://link.springer.com/article/10.1186/s12889-021-10187-z/fulltext.html |
geographic |
Canada Nunavut |
geographic_facet |
Canada Nunavut |
genre |
inuit Nunavut |
genre_facet |
inuit Nunavut |
op_source |
BMC Public Health volume 21, issue 1 ISSN 1471-2458 |
op_rights |
http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/licenses/by/4.0/ |
op_rightsnorm |
CC-BY |
op_doi |
https://doi.org/10.1186/s12889-021-10187-z |
container_title |
BMC Public Health |
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21 |
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1 |
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1766046137633996800 |